Post-traumatic
stress disorder (PTSD) is an extremely debilitating condition that can occur
after exposure to a terrifying event or ordeal in which grave physical harm
occurred or was threatened. Traumatic events that can trigger PTSD include
violent personal assaults such as rape or mugging, natural or human-caused
disasters, accidents, or military combat.

Military troops who served in Vietnam and the Gulf Wars; rescue workers
involved in the aftermath of the Oklahoma City bombing; survivors of accidents,
rape, physical and sexual abuse, and other crimes; immigrants fleeing violence
in their countries; survivors of the 1994 California earthquake, the 1997 South
Dakota floods, and hurricanes Hugo and Andrew; and people who witnesses
traumatic events are among the people who develop PTSD. Families of victims can
also develop the disorder.

Fortunately, through research supported by the National Institute of Mental
Health (NIMH) and the Department of Veterans Affairs (VA), effective treatments
have been developed to help people with PTSD. Research is also helping
scientists better understand the condition and how it affects the brain and the
rest of the body.

NIMH is conducting a national education program on anxiety disorders, which
include PTSD, panic disorder, obsessive-compulsive disorder, phobias, and
generalized anxiety disorder.

What Are the Symptoms of PTSD?
Many people with PTSD repeatedly re-experience the ordeal in the form of
flashback episodes, memories, nightmares, or frightening thoughts, especially
when they are exposed to events or objects reminiscent of the trauma.
Anniversaries of the event can also trigger symptoms. People with PTSD also
experience emotional numbness and sleep disturbances, depression, anxiety, and
irritability or outbursts of anger. Feelings of intense guilt are also common.
Most people with PTSD try to avoid any reminders or thoughts of the ordeal.
PTSD is diagnosed when symptoms last more than one month.

How Common Is PTSD?
At least 4 percent of U.S. adults (5.7 million people) have PTSD during the
course of a year. About 30 percent of the men and women who have spent time in
war zones experience PTSD. One million war veterans developed PTSD after
serving in Vietnam. PTSD has also been detected among veterans of the Persian
Gulf War, with some estimates running as high as 8 percent.

When Does PTSD First Occur?
PTSD can develop at any age, including in childhood. Symptoms typically begin
within 3 months of a traumatic event, although occasionally they do not begin
until years later. Once PTSD occurs, the severity and duration of the illness
varies. Some people recover within 6 months, while others suffer much longer.

What Treatments Are Available for PTSD?
Research has demonstrated the effectiveness of cognitive-behavioral therapy,
group therapy, and exposure therapy, in which the patient repeatedly relives
the frightening experience under controlled conditions to help him or her work
through the trauma, as well as medications that help ease the symptoms of
depression and anxiety and help promote sleep. Scientists are attempting to
determine which treatments work best for which type of trauma.

Do Other Physical or Emotional Illnesses Tend
to Accompany PTSD?
Co-occurring depression, alcohol or other substance abuse, or another anxiety
disorder are not uncommon. The likelihood of treatment success is increased
when these other conditions are appropriately diagnosed and treated as well.
Headaches, gastrointestinal complaints, immune system problems, dizziness,
chest pain, or discomfort in other parts of the body are common. Often, doctors
treat the symptoms without being aware that they stem from PTSD.
NIMH, through its education program, is encouraging primary care providers to
ask patients about experiences with violence, recent losses, and traumatic
events, especially if symptoms keep recurring. When PTSD is diagnosed, referral
to a mental health professional who has had experience treating people with the
disorder is recommended.

Who Is Most Likely to Develop PTSD?
People who have been abused as children or who have had other previous
traumatic experiences are more likely to develop the disorder. Research is
continuing to pinpoint other factors that may lead to PTSD.

What Are Scientists Learning From Research?
NIMH and the VA sponsor a wide range of basic, clinical, and genetic studies of
PTSD. In addition, NIMH has a special funding mechanism, called RAPID Grants,
which allows researchers to immediately visit the scenes of disasters, such as
plane crashes or floods and hurricanes, to study the acute effects of the event
and the effectiveness of early intervention.Research has shown that PTSD clearly alters a number
of fundamental brain mechanisms. Because of this, abnormalities have been
detected in brain chemicals that mediate coping behavior, learning, and memory
among people with the disorder. Recent brain imaging studies have detected
altered metabolism and blood flow as well as anatomical changes in people with
PTSD.

The following are also recent research
findings:

Some studies show that debriefing people very soon after a catastrophic event
may reduce some of the symptoms of PTSD. A study of 12,000 schoolchildren who
lived through a hurricane in Hawaii found that those who got counseling early
on were doing much better two years later than those who did not. People with
PTSD tend to have abnormal levels of key hormones involved in response to
stress. Cortisol levels are lower than normal and epinephrine and norepinephrine
are higher than normal. Scientists have also found that people with this
condition have alterations in the function of the thyroid and in
neurotransmitter activity involving serotonin and opiates. When people are in
danger, they produce high levels of natural opiates, which can temporarily mask
pain. Scientists have found that people with PTSD continue to produce those
higher levels even after the danger has passed; this may lead to the blunted
emotions associated with the condition. It used to be believed that people who
tend to dissociate themselves from a
trauma were showing a healthy response, but now some researchers suspect that
people who experience dissociation may be more prone to PTSD. Animal studies
show that the hippocampus -- a part of the brain critical to emotion-laden
memories -- appears to be smaller in cases of PTSD. Brain imaging studies
indicate similar findings in humans. Scientists are investigating whether this
is related to short-term memory problems. Changes in the hippocampus are thought
to be responsible for intrusive memories and
flashbacks that occur in people with this disorder. Research to understand the
eurotransmitter system involved in memories of emotionally charged events may
lead to discovery of drugs that, if given early, could block the development of
PTSD symptoms.
Levels of CRF, or corticotrophin releasing factor--the ignition switch in the
human stress response--seem to be elevated in people with PTSD, which may
account for the tendency to be easily startled. Because of this finding,
scientists now want to determine whether drugs that reduce CRF activity are
useful in treating the disorder.

Reporters: For more information about post-traumatic stress disorder and other
anxiety disorders, contact: The Anxiety Disorders Education Program, National
Institute of Mental Health at 301/443-4536. The general public can obtain
publications by calling NIMH’s toll-free information service, 1-88-88-ANXIETY;
information is also available online from NIMH’s home page: http://www.nimh.nih.gov/anxiety.

Post-traumatic
stress disorder is a disorder that occurs after a person has experienced a
traumatic event, such as a natural disaster, participating in combat, or being
the victim of a physical assault or rape. Stressors that might trigger PTSD
must be outside the range of typical human experience. Typical problems such as
grieving the loss of a loved one or marital conflict are not considered severe
enough to lead to PTSD. People who have PTSD are people who:

Have experienced,
witnessed, or were confronted with a traumatic event which involved the
threat of death or serious injury of themselves or others and the person
responded with intense fear, helplessness, or horror.

Persistently
re-experience the event through intrusive thoughts, dreams, acting or
feeling as if the event were reoccurring, and/or intense distress and
psychological reactivity when exposed to cues that symbolize or resemble
the event.

Avoid stimuli associated
with the event and numbing of general responsiveness by:

Avoiding thoughts,
feelings, conversation, activities, places, or people associated with the
trauma.

An inability to recall
important aspects of trauma.

A loss interest in
participating in activities.

A feeling of
detachment from others.

A restricted range of
emotions, often unable to have loving relationships.

These disturbances
continue at least a month and cause significant distress or impairment in
social, occupational, or other important areas of functioning.

Traumatic
events are more likely to lead to PTSD if they are the result of human malice
as opposed to an accident or a natural disaster. Prevalence of this disorder is
somewhere between 1 and 5% of the American population. Most men who have the
disorder have experienced combat and most women have been the victim of a
physical assault or rape.

The
symptoms of PTSD not only affect the sufferer, but also may impact severely on
other family members. Relationships with partners and children may become
strained and difficult. PTSD may cause the sufferer to reject or withdraw from
the very people who care most.

PTSD is
understood in terms of three groups of symptoms. They can affect individuals
and families in the following ways.

Intrusive
Symptoms

Traumatic
events typically "intrude" into the lives of PTSD sufferers. This can
happen in vivid daytime memories or dreams. It can occur suddenly and without
obvious cause and is typically accompanied by intense emotions, such as grief,
guilt, fear or anger. Sometimes, these intrusions can be so strong or vivid
that the individual may believe the trauma is re-occurring.

These
symptoms can be frightening not only for the individual experiencing them, but
also for other family members. These intrusive symptoms can cause families to
feel worried about the PTSD sufferer or perplexed by their behavior. The
individual may make movements or noises when dreaming, which is very disturbing
for partners.

Avoidance

Traumatic
memories are extremely unpleasant and individuals may try to avoid any
situations, people or events, which remind them of the incident(s). They may
attempt to block out the memories by withdrawing into themselves, cutting
themselves off from other people. They may feel unable to respond appropriately
to others and to the challenges of everyday life. PTSD sufferers often report
being unable to feel emotions, even for those to whom they feel closest.
Importantly, this does not mean that they no longer love or care for their
family and friends.

This
emotional avoidance and numbing inevitably affects relationships. The lack of
energy and the tendency to withdraw is difficult for families to understand or
tolerate. Family members may feel rebuffed by a PTSD sufferer who is unable to
show appropriate involvement, emotion and affection. This can be particularly
hard on children. Family members may feel frustrated at having to take on
responsibilities the traumatized person can no longer meet.

Arousal
Symptoms

Severe
trauma can cause individuals to feel vulnerable and frightened. They may be
"jumpy" and feel the need to be constantly on guard and watchful.
Sleep is often disturbed and restless. They may feel irritable and angry with
themselves and others. This may sometimes lead to aggressive and violent
behavior. Memory, concentration, and decision-making are often affected.

The effect
of these symptoms on the family can be severe. Anger and irritability can be
one of the most difficult symptoms of PTSD for families to endure, especially
when the anger is directed at children. Anxiety can cause many difficulties,
especially if the sufferer avoids going to shops or crowded places.

Associated Problems

In addition
to the core PTSD symptoms, it is common for sufferers to experience feelings of
panic or extreme fear, especially when away from home or other "safe"
places. Depression, loss of interest in normal activities, and reduced
motivation are also common.

PTSD
sufferers often engage in potentially harmful habits and behaviors to cope with
their symptoms. Thus, they may abuse alcohol or other drugs as a form of
"self-medication" in an attempt to blunt memory. Again, this can be
very difficult for families to cope with.

Recognizing PTSD

If PTSD is
not recognized as the cause of the problems, family members may start to blame
the affected person or themselves. They may feel rejected or unloved, and
powerless to help the sufferer. It may mean that the family will require help
with other problems that they had been coping with before.

Unfortunately, PTSD can be a difficult disorder
to recognize because there is often:

A reluctance to talk
about the traumatic event(s) and personal reactions, for fear of appearing
weak or stupid.

Unhelpful attitudes in
others; e.g., beliefs that PTSD does not exist or that the survivor should
"just pull themselves together".

A variation in the
intensity of symptoms over time - the sufferer may be relatively well for
long periods between episodes. Sometimes symptoms may not appear for some
months, or even years, after the trauma.

What To Do If A Member
Of Your Family Has Symptoms Of PTSD

Offer general support:
the security offered by loved ones is critical to recovery.

Encourage the sufferer
to talk about what happened and how they are feeling: this is a crucial
part of helping. Try not to judge them or offer advice that they cannot follow.

Acknowledge and attempt
to understand the individual’s reactions to what they have experienced.
This may be as simple as recognizing that PTSD can cause the same person
to react with extreme anger and numbed feelings at different times.

Where symptoms are severe, or last for a long
time, the person should be seen by an experienced mental health professional.
Untreated, PTSD can become a chronic and disabling disorder. Diagnosis and
effective treatment should be sought at the earliest opportunity. Family
members can play an important role in encouraging the individual to seek
treatment and in providing on-going support during the treatment process.

You may wish to talk to your family doctor or
community health center about where to get treatment for your loved one. You
could also try your local Vietnam Veterans Counseling Service (VVCS) - they may
be able to help even if the person is not a veteran.